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About Us

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Medicine in Specialist Schools

About Us

MiSS seeks to give a voice to school leaders in specialist provision, who want to ensure that their pupils receive high quality health and medical support while they are in school.

Mission Statement

Children with complex needs deserve the highest quality health and medical services to be provided in their schools, so that they feel safe and can learn well.

MiSS Platform - March 2020

The last decade has seen the emergence of a sudden increase in demand for clinical medical services to be provided in specialist schools.

Local commissioning responses have been ad hoc and resulted in a divergent national picture. This has included unilateral withdrawal of nursing services from specialist schools across England. As a result, children have been put at risk, and on occasions harmed.

Fundamental misunderstandings of national policy, underlie the decision-making of
commissioners, these include:

  • a. ‘delegation of nursing tasks' from registered medical professionals to support workers is often believed to be mandatory for schools;
  • the Designated Schools Grant operates as a 'bank of last resort' under the School Funding Regs (Schedule 2, Part 5, Para 39) and must fund "special medical services" if the local CCG or NHS Trust does not make alternative arrangements;
  • the 2013 transfer of Public Health Duty to LAs saw 'school nursing' move into local authority control, and many CCG commissioners did not know there was another parallel service providing clinical nursing services in specialist schools.

There are policy 'fixes' that can be identified:

  • NHS England to create a national metric to categorise and quantify the objective clinical need across the specialist school estate;
  • NHS England to provide clarity around the responsibility of NHS employers to secure partnership agreements with providers of specialist schools when registered nurses delegate medical tasks to support workers in specialist schools;
  • DfE to issue supplemental guidance for Directors of Children's Services and governing bodies that extends the 2015 circular 'Supporting Children at School with Medical Conditions' with a specific statutory guidance document to describe "providing clinical services in partnership with NHS providers";
  • DfE to review the annually published School Funding Regs and Operational Guidance document suite, to clarify the meaning of “Therapies”;
  • the remits of Ofsted and CQC to be reviewed to clarify which agency leads the accountability for clinical services provided in specialist schools.

This is an issue the national SEND Review could get hold of, and actually improve quickly, as it does not rely on additional financial resources to be moved forward, just great clarity of thought, and a modest amount of inter-departmental resolution.

The Medicine in Specialist Schools steering group is led by eight specialist school headteachers who lead networks in each of the DfE regions, chaired by Special Schools Voice, who seek to fairly reflect the views of thousands of parents, staff and governors, in hundreds of specialist schools and settings.

The MiSS steering group seeks to move the policy dialogue forward at local, regional and national level, and to work in partnership with all agencies in order to secure the best outcomes for the most vulnerable children. We believe in excellent inclusive education.

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